CPT code 33606 is used for the procedure involving the connection of an artery to the aorta, typically during heart surgery.
CPT code 33606 is used to describe the surgical procedure of creating an anastomosis, which is a connection between an artery and the aorta. This procedure is typically performed to improve blood flow in patients with certain cardiovascular conditions. The code is part of the cardiovascular surgical procedures category and is used by healthcare providers to document and bill for this specific type of surgery.
For CPT code 33606, which involves anastomosis of an artery to the aorta, the following modifiers may be applicable depending on the specific circumstances of the procedure:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. This could be due to complications or unexpected findings during the surgery.
2. Modifier 51 - Multiple Procedures: If multiple procedures are performed during the same surgical session, this modifier indicates that the procedure is one of several performed.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that the procedure is distinct or independent from other services performed on the same day. It is often used to bypass National Correct Coding Initiative (NCCI) edits.
4. Modifier 62 - Two Surgeons: When two surgeons work together as primary surgeons performing distinct parts of a procedure, this modifier is applicable.
5. Modifier 66 - Surgical Team: If the procedure requires a surgical team due to its complexity, this modifier is used to indicate that a team of surgeons was necessary.
6. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is used if the patient needs to return to the operating room for a related procedure during the postoperative period.
7. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when an unrelated procedure is performed by the same physician during the postoperative period of the initial procedure.
These modifiers help provide additional information about the circumstances under which the procedure was performed, ensuring accurate billing and reimbursement. Always verify with the latest coding guidelines and payer-specific requirements as they can vary.
CPT code 33606 is subject to reimbursement by Medicare, but its coverage and payment are determined by several factors. The Medicare Physician Fee Schedule (MPFS) plays a crucial role in establishing the payment rates for services covered under Medicare Part B, including those represented by CPT codes. The MPFS outlines the reimbursement rates for various procedures, taking into account factors such as the relative value units (RVUs) assigned to the procedure, geographic location, and other considerations.
However, the final determination of whether CPT code 33606 is reimbursed by Medicare can also depend on the policies set by the Medicare Administrative Contractor (MAC) for the specific region. MACs are responsible for processing Medicare claims and have the authority to establish local coverage determinations (LCDs) that may affect the reimbursement of certain procedures. These LCDs can vary by region and may include specific criteria that must be met for a procedure to be covered.
Therefore, while CPT code 33606 is included in the MPFS, healthcare providers should verify with their local MAC to ensure compliance with any regional coverage requirements and confirm the reimbursement status for this specific code.
Discover how MD Clarity's RevFind software can enhance your revenue cycle management by accurately reading your contracts and detecting underpayments down to the CPT code level, including CPT code 33606, and by individual payer. Schedule a demo today to see how RevFind can ensure you're receiving the full reimbursement you deserve.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
